American Indians (AIs) experience a disproportionately high incidence of cerebrovascular disease (CBVD) relative to non-Indians with twice the stroke rate of the general US population. Neuroimaging techniques have shown CBVD-related brain abnormalities to be associated with disruption of neurpsychological performance. Therapy for post-stroke cognitive impairment has been challenging. Cognitive therapy involves intense, focused, regular mental activity, intellectual stimulation, and behaviora exercises that assist individuals to regain or maintain cognitive function. and reduce the risk of age-related cognitive decline and dementia after brain insult. Interactive Metronome (IM) therapy is a promising form of behavioral therapy for CBVD-related cognitive and motor function. This technology uses operant conditioning of an individual's responses through simple, repetitive motor tasks (e.g., clapping hands, tapping feet) in time with a set beat. Through visual and auditory feedback, IM addresses processing speed, attention, and immediate and delayed memory, all of which can be affected by CBVD. IM therapy can improve quality of life, physical mobility, gait, and CBVD- related cognitive deficits. The ongoing Strong Heart Stroke Study (SHSS) (1R01HL093086-01A1; Dedra Buchwald, PI) is investigating CBVD-related brain abnormalities through MRI scans on 1000 AIs from the original SHS cohort. The proposed study will capitalize on this current SHSS to conduct a randomized, controlled trial to ascertain the effects of a culturally tailored IM intervention on cognition, depression, and quality of life. We ill target SHSS participants with subclinical CVBD defined by impaired cognitive processing speed. We will select a sample of 180 American Indians age 68 to 80 years participating in the SHSS. The specific Aims for this study of older American Indians are as follows: 1) Determine if the culturally-adapted IM intervention can improve cognitive functioning among older AIs with CBVD; and 2) Estimate the impact of IM on health-related quality of life. This study will yield important insights into the relationships among cognitive and motor rehabilitation, neuropsychological assessment, and brain abnormalities that can inform treatment efforts as one way to reducing AI CBVD disparities.